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Establishing what treatment options patients with obesity complications prefer

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Establishing what treatment options patients with obesity complications prefer

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Listening and incorporating patient preferences in the treatment of obesity should be an integral part of our management of obesity.  Incorporating the patient’s perspective increases the likelihood of achieving buy-in from the patient and ensures that the aims of both the healthcare provider and the patient are aligned. Furthermore, patient-centred obesity care enhances a patient’s autonomy allowing them to  decide the that suits them best based on their values and need.  For patients with obesity, this is of great importance as they often suffer with shame and discrimination around their disease, and are reluctant to seek help because of weight stigmatisation.  Healthcare providers and patients establishing the optimal obesity treatment  also have the potential to lead to better adherence to treatment plans and better health outcomes.  There are limited studies on patient preferences for the treatment of obesity and it’s complications. Therefore, developing effective treatment plans or indeed obesity health policy is a challenge without knowing what patients preferences may be. The objective of this study is to evaluate what treatments options patients with obesity and it’s complications prefer.

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The need: Obesity is a chronic illness the management of which requires a multifactorial approach

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The need: Obesity is a chronic illness the management of which requires a multifactorial approach

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Paul Winters, Patient at Adult Weight Management Clinic 'Obesity is a real life-threatening condition that should be treated in the same manner as any other illnesses that threaten a person͛s mortality. '
The World Health Organisation has predicted that by 2030 Ireland will be one of the most overweight countries in the EU.  The expert report from the RCPI found that healthcare costs will increase as obesity increases due to obesity complications (NCDs) such as cardiovascular disease, type 2 diabetes, NALFD etc.  In 2009 the direct and indirect costs was estimated at €1.13 billion, 35% of costs were due to hospital care and drugs with 65% due to premature mortality and those being absent due to illness. They identified that health resources were targeting the disease outcomes of obesity that they needed to be addressing prevention and treatment of obesity.  As such there is a need to focus health services to tackle the risk factors that create obesity and other chronic illnesses.

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The clinical importance of patient preferences

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The clinical importance of patient preferences

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Patient preferences are influenced by local culture, beliefs and attitudes. They play an essential role in the adherence to treatment and improved treatment outcomes. Patient preferences help inform choices in clinical decisions and if incorporated, studies have found they could make interventions more effective. Increasing patient involvement in decision making, can improve health outcomes as patients become highly compliant in the agreed treatments for their health care. When deciding which treatment options are most valuable for patients, shared decision making assists the teams to consider other aspects that have a higher relevance to each patient’s quality of life.  Providing a structure that allows both the patient and clinician to include their values and beliefs would assist in establishing the optimal approach for each patient.  This involves a partnership between health care professionals and patients and has been shown to improve the health care quality, utilisation and outcomes.

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The importance of patient centred approaches to obesity management

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The importance of patient centred approaches to obesity management

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Patient centred care focuses on the patient and their health needs.  It is also the term used to empower patients to engage and participate more fully in their health care.  Patient centred care has translated into greater adherence to prescribed treatment and outcomes as well as better satisfaction with the health service engagement.  John Fastena et al outline a number of dimensions of patient centred care which include; patient preferences, values and needs, coordination and integration of care, information, education and communications, access to care and services, physical comfort, emotional support, involvement of family and friends and continuity and transition of care.  Patient centred care can improve outcomes however strategies for patient centred care for people with obesity are lacking.  Health care professionals should look at patients with obesity holistically and recognise that what might work for one patient may not work for another.  Working with the patient’s preferences, contributory factors limiting weight reduction can be identified and taken into account to help with improvement in comorbid conditions.

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The impact of patient preferences on health policy

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The impact of patient preferences on health policy

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Public health organisations have to strike a balance between the collective wellbeing, an individual’s concerns and the costs of chronic illnesses. Public health policies attempt to protect people from a disease through prevention. Public health programmes take a utilitarian approach, the greatest good for the greatest number of people.  The emphasis is on the collective and social responsibility. This can translate to taking a paternalistic approach to prevent people conducting in unhealthy behaviours and this can limit people’s choices.  Limiting choices can seem justified to prevent a disease for example the stop smoking campaigns.  In the case of obesity the primary focus is on lifestyle interventions. This is not without merit as studies have reported improvement in outcomes for patients with obesity due to patient education with 64% showing improvement in behaviours, 30% no effect and 6% showed worse behaviour.  However, this could prevent more effective treatments and therapies being contemplated as the lack of understanding about obesity can influence policies.

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Obesity is a chronic illness.  It is defined by the World Health Organisation (WHO) as abnormal or excessive fat accumulation, with a body mass index (BMI) that is over 30 kg/m², which is considered a risk to health. Control of body weight at a set point, is the product of genes and the environment.  Each person has a different set point which is the regulatory system or part of the brain that maintains weight The set point is the baseline in our bodies that maintains our weight.  Some people have a higher set point, and our body’s homeostatic controls work to keep our weight within that range.  In the case of obesity, the set point or biological control fails due to external factors such as diet or the environment and consequently the body reaches for a setpoint which increases weight.

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Evidence for a set point that regulates human body weight

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Evidence for a set point that regulates human body weight

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Control of body weight at a set point, is the product of genes and the environment.  Each person has a different set point which is the regulatory system or part of the brain that maintains weight

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Determinants and Consequences of Obesity

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Determinants and Consequences of Obesity

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Prevention helps by promoting the limitation of weight gain through healthy dietary and lifestyle behaviours.  This is part of the multi factoral approach needed to tackle this disease especially as it has been show that genetic factors predispose individuals to obesity.

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The prevalence of obesity is rising across all European countries and rising quickest in low socioeconomic populations.  There are very few studies that focus on interventions that address how best to reduce inequities in obesity.

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Economic impacts of overweight and obesity

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Economic impacts of overweight and obesity

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The economic impacts of obesity are substantial across countries, irrespective of economic or geographical context and will increase over time if current trends continue. The cost is substantial as a number of illnesses result from it and this is likely to increase.

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The signalling pathways between the brain and the gut govern homeostasis. Homeostasis means the balance of the self-regulating process that maintains stability in respect to weight stability which is regulated by the gut and the brain to regulate the gut

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The Foresight report states “At the heart of obesity lies a homeostatic biological system that struggles to maintain energy balance to keep the body at a constant weight from just the first few months of life”.  As such it is more complex and one solution will not meet the needs of all. The Foresight obesity system map (shown here) describes the complex drivers of obesity.

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Model of Care of Management of Overweight and Obesity

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Model of Care of Management of Overweight and Obesity

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Chronic Disease Management in Ireland - overview - implications and recommendations (Darker et al., 2015)

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Health Challenge: People with obesity have a high risk of developing a number of chronic illness

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Health Challenge: People with obesity have a high risk of developing a number of chronic illness

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Obesity is a damaging illness both clinically and psychologically.  People with obesity have a high risk of developing a number of chronic illnesses.  One literature review found that obesity is related to at least 18 co-morbidities.

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Dramatics increase in chronic diseases increases hospital activity that it will become unsustainable

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Dramatics increase in chronic diseases increases hospital activity that it will become unsustainable

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Six out of every ten in the population is overweight or obese which means that there will be a dramatic increase in chronic diseases. The national obesity strategy found that obesity-related chronic diseases are increasing hospital activity to the extent that it will become unsustainable unless real action is taken.

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Health Challenge: NAFLD is a serious complication of obesity that is on the increase

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Health Challenge: NAFLD is a serious complication of obesity that is on the increase

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Non-alcoholic fatty liver disease (NAFLD) is a build-up of fat in the liver in people who consume little or no alcohol. NAFLD is the most common cause of chronic liver disease and is linked with heart disease.  The prevalence of NAFLD is 80%-90% in those with obesity and 30%-50% in those with diabetes.

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Health Challenge: Obesity has a negative effect on kidneys and can lead to the complication of CKD

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Health Challenge: Obesity has a negative effect on kidneys and can lead to the complication of CKD

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Obesity has a negative effect on the kidneys and can lead to renal disease.  The kidneys clear the body of waste and toxins and return what the body needs to the bloodstream.  Chronic kidney disease (CKD) is a disruption of this and can lead to heart failure and stroke. A high BMI is associated with an increased risk for developing end stage renal disease (ESRD)

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Health Challenge: Individuals with a BMi greater than 30 kg/m2 higher risk of CKD

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Health Challenge: Individuals with a BMi greater than 30 kg/m2 higher risk of CKD

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A meta-analysis, reviewing 5 million individuals from 40 countries, in 63 population cohorts, looked at studies published between 1970 and 2017. It established that individuals with a BMI greater than 30 kg/m² were at a higher risk of kidney disease.

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Research has established that those with a BMI of 30 kg/m2  have 28 times greater risk of developing diabetes and this risk increases to 93 times higher if the BMI is 35 or above.

Worldwide it is estimated that 9415 million people have diabetes, 90% of whom had type 2 diabetes.  A common pathology in obesity and type 2 diabetes is insulin resistance which means  insulin is no longer effective in regulating glucose levels in the body’s cells which leads to hyperglycaemia and eventually diabetes.

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Health Challenge: Obesity and diabetes impact's people's health related quality of life

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Health Challenge: Obesity and diabetes impact's people's health related quality of life

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People with obesity and diabetes have a series of long-term health complications including damage to the heart, legs, bones, eyes, kidneys, feet, nerves and brain which studies show and type 2 diabetes impacts people’s health related quality of life (HRQOL)

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Increases in chronic illnesses will increase health care costs to €5.4 billion by 2030 

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Increases in chronic illnesses will increase health care costs to €5.4 billion by 2030 

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There is now a greater understanding of the complications associated with obesity and an increasing awareness of the need to provide treatment.  Treatment options such as low-calorie diets, medications or metabolic surgery that produces >10% or >15% of weight loss can make a significant health improvement to those with obesity. The incidence of the complication’s obesity such as liver disease, diabetes and cancer is increasing which has a substantial negative impact on patient’s morbidity and mortality.  These complications also adversely affect a patient’s quality of life. Keaver et al found that overweight and obesity is projected to reach levels as high as  89% and 85% in males and females by 2030. This will result in a corresponding increase in obesity related complications, and projections are that diabetes will increase by 21%, cancers by 61% and coronary heart disease (CHD) and stroke by 97%.  In Ireland these increases in chronic illnesses will increase health care costs to €5.4 billion by 2030

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Your access to the NCBI website at www.ncbi.nlm.nih.gov has been temporarily blocked due to a possible misuse/abuse situation involving your site. This is not an indication of a security issue such as a virus or attack.

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Sociocultural assessment hold that people with obesity and obesity complications are solely responsible for their condition.

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Sociocultural assessment hold that people with obesity and obesity complications are solely responsible for their condition.

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There are multiple opinions on what obesity is.  Sociocultural assessments take the approach that people are held solely responsible for their condition. The consistent view in the media is that it is the individual’s fault portraying those with a lot of weight as unintelligent and lazy.  People with a lot of weight are often characterised as being undisciplined and solely responsible for their condition.

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Patients with obesity often suffer bias and stigma

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Patients with obesity often suffer bias and stigma

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In addition to  chronic health issues people with obesity often suffer with low self-esteem and depression and frequently experience stigma about their obesity.

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The media portray it as the War on Obesity but in fact it is often the War on fat people.  Invariably the narrative is around a self-inflicted disorder due to a lack of willpower and poor self-control.  Societal responses to date that view  the cause and solution to the obesity epidemic as  purely the responsibility of the individual have been used to justify stigmatizing people.

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Obesity Stigma - Considerations for Public Health

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Obesity Stigma - Considerations for Public Health

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Many people with obesity complications experience weight stigma. Using weight stigma under the guise of benefiting society is not an effective strategy. In fact it creates health disparities.  When people are blamed for their disease it creates disease stigma.

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Stigmatisation does not change the outcome for patient's with obesity complications

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Stigmatisation does not change the outcome for patient's with obesity complications

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Stigmatization does not change the outcome for people with obesity or obesity complications, in fact it can cause other harms such as depression, anxiety, avoidance of health care

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The Harm of Bioethics: A Critique of Singer and Callahan on Obesity

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Debate concerning the social impact of obesity has been ongoing since at least the 1980s. Bioethicists, however, have been relatively silent. If obesity is addressed it tends to be in the context of ...

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Tackling Obesity and obesity complications: how to fight the emerging crisis

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Tackling Obesity and obesity complications: how to fight the emerging crisis

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We need to reframe the question and look at holistic solutions working at prevention but providing treatments options to create sustainable solutions.

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Francesco Rubino at ECIPE Seminar: Tackling Obesity in Europe - How to Fight an Emerging Crisis?

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Overeating doesn’t cause obesity, but obesity causes overeating

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Overeating doesn’t cause obesity, but obesity causes overeating

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If you think overeating causes obesity it disrupts sustainable development because you need to fundamentally reorganise society, but if you think obesity causes overeating and you address the biological drivers then it becomes a much more economically sustainable.

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Posted On: 14th June 2019
"We now treat obesity like all other chronic diseases, and we understand the value of meal replacement strategies which helps change the symptoms of hunger and lack of satiety in a subpopulation of people with the disease of obesity. For these people losing weight is effortless as the meal replacements addresses the underlying biology of the disease."
Carel Le Roux, professor of metabolic medicine at University College Dublin, proposes in his interview that officially recognising obesity as a disease will change our understanding and approach to treating it. This, he argues, would allow medical professionals to examine obesity in separate stages: causes, symptoms, and complications. Once the symptoms of obesity are targeted, there is a greater chance of successful weight management.

So, what would be achievable if other countries were to officially recognise obesity as a disease? Portugal officially classified obesity as a chronic disease in 2014, but still remains the only country in Europe to do so. Doctors in the UK have been outspoken in their convictions that obesity should be designated a disease and should no longer be considered a lifestyle choice - they called on the government to enforce this reclassification so that patients can receive specialist care.

Classifying obesity as a chronic disease would allow the creation of formal policies to improve care in the medical field, so that preventative measures can be put in place. Le Roux also believes sufficient legislation is an essential step towards tackling the stigma of obesity, a statement echoed by the President of the Royal College of Physicians: " It is important to the health of the nation that we remove the stigma associated with obesity ". This stigma, Le Roux argues, only compounds the problem. Not everyone has control over their lifestyle; access to healthy food, exercise and information around nutrition has become something of a privilege. Furthermore, many well-known conditions are lifestyle-related, such as heart disease, yet patients suffering from these conditions are not blamed to the extent that diabetes patients often are. Often not triggered by lifestyle factors, diabetes can be caused by health inequalities, genetic influences and social factors - all causes that are largely out of the patient's control.

The decision to prescribe total meal replacement diets (TDRs) on the NHS is a positive sign that the medical field recognises obesity as a disease that can be treated and controlled by healthcare professionals. Professor Jonathan Valabhji, National Clinical Director of Diabetes and Obesity for the NHS in England said: "" Our work so far in this area has been producing really positive results and today's announcement will allow us to go even further - it will help patients who have Type 2 diabetes to achieve remission and importantly, help more of those who are at risk to not get it in the first place."

Le Roux's approach to TDRs is very simple: If a patient is responding well to a diet approach, it is beneficial to continue; if a patient does not seem to respond well, then the medical professional may look at modifying the diet or considering alternative options. Members of TDMR Europe take care to carry out extensive consultations with people who wish to lose weight in order to design a tailored weight management programme that works for them. In choosing the right option, different factors should be taken into account: the amount of weight to lose, the general health and fitness of each individual and the cost-effectiveness of the proposed solution, as well as personal preferences

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Obesity: disease or lifestyle choice? An interview with Carel Le Roux

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"We now treat obesity like all other chronic diseases, and we understand the value of meal replacement strategies which helps change the symptoms of hunger and lack of satiety in a subpopulation of people with the disease of obesity. For these people losing weight is effortless as the meal replacements addresses the underlying biology of the disease."

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Finding solutions: recognising obesity as a disease.

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Finding solutions: recognising obesity as a disease.

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If obesity is recognised as a disease, then it becomes less challenging to find solutions for health care challenges in their own health contexts and systems.  Different countries have acknowledge it and others have not.

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The prevalence of obesity among adolescents in Europe continues to increase, according to a report from WHO published in May, 2017. The report showed that prevalence of obesity was generally higher in younger adolescents than in older adolescents, presumably as a result of the ever-increasing prevalence of obesity in childhood. Childhood obesity has continued to increase worldwide, a gravely worrying trend that led to a reversal of this increase being among the UN Sustainable Development Goals. In a position paper published on May 10, 2017, the World Obesity Federation argue that "early diagnosis and treatment of childhood obesity could be considered similar to vaccination"-preventing a disease through proactive policy. But for effective prevention strategies such as these to be realised, obesity must be recognised as a disease.

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Should we officially recognise obesity as a disease?

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The prevalence of obesity among adolescents in Europe continues to increase, according to a report from WHO published in May, 2017. The report showed that prevalence of obesity was generally higher in younger adolescents than in older adolescents, presumably as a result of the ever-increasing prevalence of obesity in childhood.

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Sustainability of Solution: Providing Treatment for obesity and obesity complications

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Sustainability of Solution: Providing Treatment for obesity and obesity complications

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Investing in obesity treatment to benefit patients and deliver significant healthcare savings. Options such as surgery, medication and lifestyle programmes. Treatment and prevention programmes are needed to run in tandem in order to make some progress with this disease.

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The importance of patient preferences in managing obesity and obesity complications

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The importance of patient preferences in managing obesity and obesity complications

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Patient preferences are influenced by local culture, beliefs and attitudes. They play an essential role in the  adherence to treatment and improved treatment outcomes. Patient preferences help inform choices in clinical decisions and if incorporated, studies have found they could make interventions more effective. Increasing patient involvement in decision making, can improve health outcomes as patients become highly compliant in the agreed treatments for their health care.

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Incorporating patient preferences is essential in Chronic Disease management

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Incorporating patient preferences is essential in Chronic Disease management

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Listening and incorporating patient preferences in the treatment of obesity should be an integral part of our management of obesity.  Incorporating the patient’s perspective increases the likelihood of achieving buy-in from the patient and ensures that the aims of both the healthcare provider and the patient are aligned.

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An Integrated Approach to Tackling Obesity is Essential

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An Integrated Approach to Tackling Obesity is Essential

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An integrated approach to obesity is essential. We have to try to work out the best treatment for each individual as responses are different for each person.

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Treatment choices range from lifestyle interventions, pharmacotherapy and bariatric surgery.  Obesity is a disease that is not the person's fault but like all diseases it is their responsibility.

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Obesity Treatment Options- Using Weight to Improve Your Health

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Lifestyle programmes for obesity are comprised of a reduced calorie diet, increasing physical activity and behavioural therapy to support adherence to diet and physical goals.

Patients who participated in intense lifestyle programmes including coaching on how to set goals, develop action plans for eating and physical activity have proven to reduce weight by 10%

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There are a number of medications available to treat obesity.  Some medications can either help the person feel less hungry or feel fuller sooner and others make it hard for the body to absorb fat.  These medications are used to help patients achieve long term weight loss.  Often  lifestyle interventions are not sufficient to maintain long term weight loss with weight regain within 5 years from ending the intervention, so consequently medications are often in tandem  with lifestyle interventions to improve outcomes

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Innovations in treatment for obesity - Online interview

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Metabolic Surgery providing results that enable the reversal of some chronic illness such as diabetes. For example normal blood glucose levels within hours of a bypass operation.

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Academic Health Science Centre Lecture Series - Helen Heneghan - Metabolic Surgery

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The benefit of pharmaceuticals in chronic illness such as diabetes has shown to improve not just weight loss but to keep some chronic illness in remission in the long term. This helps with multiple diseases and provides health gain.

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Prof. Carel Le Roux: The role of pharmaceuticals in diabetes surgery

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Advice for Health Care Professionals in assisting to develop sustainable solutions for obesity complications

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Advice for Health Care Professionals in assisting to develop sustainable solutions for obesity complications

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Acting in partnership with the patients and incorporating their preferences has proven to have positive results in tackling obesity and obesity complications

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Talking about Weight - Dr Michael Crotty

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Obesity is complex we need sustainable prevention of obesity

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Obesity is complex we need sustainable prevention of obesity

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SPOTLIGHT is a cross-European research project and stands for sustainable prevention of obesity through integrated strategies.  Supporting obesity prevention approaches by local authorities, public health and other practitioners.

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SPOTLIGHT is a cross-European research project and stands for sustainable prevention of obesity through integrated strategies. It is funded by the European Commission through its seventh Framework programme.

SPOTLIGHT will systematically define the factors necessary for establishing effective health promotion approaches. Different levels in varying contexts will be taken into account - individual, family, organisational, and environments that can change behaviour, lifestyles, and life skills to sustainably reduce obesogenic behaviours in an innovative way.

This will be done by a multidisciplinary consortium involving 13 organisations in eight European countries - Belgium, Denmark, France, Hungary, the Netherlands, Norway, Portugal and the United Kingdom.

By providing new perspectives on obesity prevention the project will support the development and implementation of effective obesity prevention approaches by local authorities, public health and other practitioners. These perspectives will maximise the use of state of the art knowledge and will help policy makers to invest necessary resources in the most effective long-term prevention efforts. In addition, it will provide a stimulus for health scientists to explore further study possibilities to reduce (the burden of) obesity and flatten the social gradient associated with it.

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SPOTLIGHT will systematically define the factors necessary for establishing effective health promotion approaches. Different levels in varying contexts will be taken into account - individual, family, organisational, and environments that can change behaviour, lifestyles, and life skills to sustainably reduce obesogenic behaviours in an innovative way.

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Providing treatment options helps establish the key drivers of weight gain, respects patient's autonomy, increases quality of life and provides health benefits and reduces health care complications.

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A Roadmap for Managing Obesity in Primary Care

Obesity Canada's 5As of Obesity Management program was designed as a step-by-step framework for busy non-specialists who manage obesity in their patients.

The framework was developed with close to $1 million in funding from the Public Health Agency of Canada and the Canadian Institutes of Health Research. It is based on several core principles that emerged from extensive consultations with patients, primary care providers and obesity experts - a process that involved numerous interviews, focus groups and surveys spanning almost three years.

The principles and messages were then crafted and tested among primary care providers at conferences and workshops across Canada. The result is an easy-to-use roadmap that ensures sensitive, realistic, measurable and sustainable obesity management strategies that focus on improving health and well-being, rather than simply aiming for numbers on a scale.
The 5As have been adapted for use in pediatrics and healthy pregnancy weight gain, and for team-based care. Check out the links below!
The following core principles were identified during the consultation processes that went into the development of the 5As framework.

A pilot study first presented at Obesity Week 2013 provides the first evidence that the implementation of the 5As of Obesity Management promotes physician-patient communications, medical assessments for obesity and plans for follow-up care in a primary care setting.

Researchers tested the impact of implementing the 5As tool in four primary care clinics with over 25 healthcare providers; the intervention consisted of one online training session (90 min) and distribution of the 5As toolkit to HCPs of participating clinics.

Based on measurements performed before (baseline, n = 51) and one month after implementing the 5As of Obesity Management (post-intervention, n = 51), the authors observed a two-fold increase in the initiation of obesity management (19 vs. 39%, P = 0.03), a statistically significant increase in the perceived follow-up/coordination efforts (self-reported Patient Assessment of Chronic Illness Care components, 45 ± 22 vs. 67 ± 12 points, P = 0.002), as well as two components of the 5As framework: Assess (50 ± 29 vs. 66 ± 15 points, P = 0.03) and Assist (54 ± 26 vs. 72 ± 13 points, P = 0.01).

The results, published in Clinical Obesity, suggest that using the 5As framework facilitates weight management in primary care - the first essential step towards any hope of promoting meaningful obesity management in primary care practice.

More evidence for the utility of the 5As has been published by 5As-Team collaborators - click the icon below.

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Core Principles A Roadmap for Managing Obesity in Primary Care Obesity Canada's 5As of Obesity Management program was designed as a step-by-step framework for busy non-specialists who manage obesity in their patients.

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Lifestyle interventions and treatment can improve outcomes

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Lifestyle interventions and treatment can improve outcomes

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Treatment options such as low-calorie diets, medications or metabolic surgery that produces >10% or >15% of weight loss can make a significant health improvement to those with obesity. For example often lifestyle interventions are not sufficient to maintain long term weight loss with weight regain within 5 years from ending the intervention, so consequently medications are often in tandem  with lifestyle interventions to improve outcomes.

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GP Dr Mick Crotty of the My Best Weight Clinic discusses new obesity drug Wegovy.

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Measuring success: reducing health care complications and costs

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Measuring success: reducing health care complications and costs

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There are no easy solutions to obesity and obesity complications.  It is a multifactorial disease that requires a multifactorial response. The response to the obesity epidemic is not purely prevention and environmental the response has to be long term and at multiple levels including prevention, treatment, support, research and education and it must be led by the state as the primary duty bearer.

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Success means acknowledging the management of this disease as a lifelong requirement

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Success means acknowledging the management of this disease as a lifelong requirement

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Obesity needs to be treated as any other complex disease from prevention, treatment, support and education. In order to help people manage this disease health care professionals and patients need to acknowledge that this disease requires lifelong management.

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Treatment Modalities of Obesity: What fits whom?

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The prevalence of obesity is increasing in both developed and developing countries, with rates reaching ∼10-35% among adults in the Euro-American region. Obesit

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The management of obesity is expensive however governments can combat additional drivers of obesity in multiple ways such as a tax on high sugar products.  In concert health professionals and institutions need to support multisectorial actions to address the drivers of obesity as a means to improve health.  Health and economic assessment are needed in order to mobilise multisectoral commitment. Prevention and management are the best way forward and are achievable, but this requires an integrated approach that incorporates patient’s preferences as health teams and patients work in alignment to tackle this chronic illness.

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Working in alignment to succeed in the management of obesity

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Working in alignment to succeed in the management of obesity

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Health care professionals should look at patients with obesity holistically and recognise that what might work for one patient may not work for another.  Working with the patient’s preferences, contributory factors limiting weight reduction can be identified and taken into account to help with improvement in comorbid conditions.

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How to Lose 50 Pounds and Keep Them Off | Arya Sharma | TEDxUAlberta

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Coordination between health care providers and patients at all levels of care and society is key to approaching obesity

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Coordination between health care providers and patients at all levels of care and society is key to approaching obesity

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If obesity is recognised as a disease then it becomes less challenging to find solutions for health care challenges in their own health contexts and systems.  For example the realisation that dyslidiaemia is a biological disease because of defects in the liver rather than diet has changed our approach to the disease.  To be able to correctly approach obesity then coordination between all levels of care and society is key.

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Choice during treatment improves therapeutic success

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Choice during treatment improves therapeutic success

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In studies it has been shown that patients given choices in a control group in the their treatment options decreased their weight significantly than other subjects in a no choice group.
Choice during treatment improves therapeutic success with overweight clients.

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Journal of Social and Clinical Psychology

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Providing subjects with a choice between treatment interventions was investigated as a means of enhancing outcome results in a behavioral weight control program for children. Subjects in the choice condition ( n = 7) were led to believe that they had chosen the type of program they participated in, while subjects in the no-choice condition ( n = 8) were assigned to a type of program. In reality, all subjects received the same 8-week treatment package. Posttreatment results indicated that subjects in the choice condition decreased both their weight (measured in pounds) and their degree of overweight (measured on the Weight Index) significantly more than did subjects in the no-choice condition. Choice effects are discussed in terms of implications for emphasizing choice during treatment to improve therapeutic success with overweight clients, as well as with other clinical populations.

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Effects of Choice on Behavioral Treatment of Overweight Children | Journal of Social and Clinical Psychology

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Providing subjects with a choice between treatment interventions was investigated as a means of enhancing outcome results in a behavioral weight control program for children. Subjects in the choice condition (n = 7) were led to believe that they had chosen the type of program they participated in, while subjects in the no-choice condition (n = 8) were assigned to a type of program.